Q&A with ZERO TO THREE on the Health of Mothers and Children

Many mothers, expectant mothers, and young children rely on Medicaid for the comprehensive services it provides, including prenatal and postpartum care, well-child visit coverage and much more. Medicaid is the safety net for millions of mothers and children that helps provide a strong start to a child’s life.

To learn more about how Medicaid helps mothers, expectant mothers, and young children, we sat down with Johanna Lister, the Director of Policy for HealthySteps, an evidence-based, team-based pediatric primary care program of ZERO TO THREE and a member of Modern Medicaid Alliance. The HealthySteps program promotes the health, well-being, and school readiness of babies and toddlers, with an emphasis on families living in low-income communities.

Modern Medicaid Alliance: What is the mission of ZERO TO THREE?

Johanna Lister: At ZERO TO THREE, our mission is to ensure that all babies have a strong start in life. We envision a society where we all have the knowledge and the will to support infants and toddlers in reaching their full potential.

Modern Medicaid Alliance: What is your role at ZERO TO THREE and what is HealthySteps?

Johanna Lister: As the Director of Policy for ZERO TO THREE’s HealthySteps program, I advise the HealthySteps national network on implications of relevant policy changes at the federal and state level. HealthySteps is an evidence-based, team-based pediatric primary care program. We partner with pediatric primary care across the country to integrate a child development professional into the care team to promote the health, wellbeing and school readiness of babies and toddlers while also saving money for public and private payers. Currently, HealthySteps supports more than 200,000 children across 22 states, the District of Columbia and Puerto Rico in more than 165 sites.

Modern Medicaid Alliance: Why did ZERO TO THREE join the Modern Medicaid Alliance?

Johanna Lister: At HealthySteps, we serve predominantly Medicaid-covered children and their families. Joining the Modern Medicaid Alliance is a great opportunity to both learn from others on what they are doing in the Medicaid space and elevate the importance of young children in the Medicaid discussion. Young children are often left out of policy and payer discussions because people assume that very young children are inexpensive and a relatively easy population to insure. While that is true to a point, prevention is incredibly powerful, and Medicaid plays a huge role in providing preventive services.

Modern Medicaid Alliance:  How does Medicaid help mothers, expectant mothers and children receive the care and support they need?

Johanna Lister: About half of all births are covered by Medicaid, making Medicaid the predominant payer of births in this country. Before a baby is born, if the mother is on Medicaid, it covers the essential and critical prenatal visits. After a baby is born, the mother is often, depending on the state she lives in, covered by Medicaid for post-partum care.

Medicaid arguably plays an even larger role in the lives and wellbeing of babies and very young children, covering a huge number of well-child visits in the first three years of life. In those well visits, they do critical care including vaccines, weight checks, and other screenings to make sure that the baby is really thriving. It also gives providers an opportunity to have multiple touchpoints with the baby and the caregiver. In the first three years of life alone, healthy babies see the doctor 12-13 times for well-child visits, with about half of those occurring in the first year of life.

At HealthySteps, we take a dyadic lens and focus on the family as a whole. In addition to making sure we’re providing the critical care, we’re also talking with the family about social determinants of health, postpartum depression, and substance use disorder that aren’t typically in the realm of pediatrics. This is where HealthySteps leverages the power of Medicaid and the many touchpoints with young children.

Modern Medicaid Alliance: What are some programs funded through Medicaid that help mothers, expectant mothers and children?

Johanna Lister: Most people know about Medicaid’s comprehensive EPSDT benefit, which works to ensure that children are screened and treated for really anything that they need, regardless of whether this service was previously covered by Medicaid. Other programs like Centering Pregnancy are covered, which is a really powerful prenatal program. Many states are moving to provide funding for doulas in Medicaid, which has been shown to reduce racial disparities around maternal mortality and morbidity.

And then there are programs like HealthySteps, where Medicaid is a huge part of our funding structure. At HealthySteps, we use that two-generation approach where it’s about the mother and child together. In many places, Medicaid funding allows HealthySteps to expand the care team and work with the parent and the young child beyond traditional Medicaid needs, like behavioral health issues in young children or helping connect mom to social determinants of health resources.

Medicaid also plays a huge role in funding part C, which are early intervention services. These are special education services under the Individuals with Disabilities and Education Act for very young children. In addition to critical services like physical therapy and occupation therapy, Medicaid pays for a lot of social emotional support for young children and families.

Modern Medicaid Alliance: Are there some Medicaid innovations in the states that help mothers, expectant mothers, and children?

Johanna Lister: The First 1,000 days program that New York and many other states have done shows that people are really starting to understand the brain science and the fact that from birth to three years old is the most critical time for brain development. One of the concrete items that came out of this program was allowing Medicaid to bill more dyadic services, when providers work with the mother and baby together. Traditionally, these services have not always been reimbursed, but as we understand the needs of very young children and these needs being inextricably tied to a mother’s needs, more and more payers, and more state Medicaid agencies are understanding the value of paying for those services.

Modern Medicaid Alliance: Where can mothers and expectant mothers learn about Medicaid enrollment?

Johanna Lister: Because Medicaid varies from state to state, there are often a number of different pathways towards enrollment. Mothers can always contact their state Medicaid agency by going to their department of health, which will provide them with resources around eligibility and enrollment.

Modern Medicaid Alliance: What threats to Medicaid concern ZERO TO THREE today?

Johanna Lister: Because it varies from state to state, where a mother lives and where a mother gives birth really matter in terms of the services that they will have access to. According to ZERO TO THREE ‘s State of Babies Yearbook, where the 12 million infants and toddlers in the United States are born and live during the first three years of life will make a big difference in their chance for a strong start in life.

What will really benefit Medicaid is a federal foundation that creates a norm in terms of some of these services. Some of the things we’d love to see at the federal level for Medicaid would be a national platform or national benchmark of one-year postpartum coverage for women after they give birth.

There are threats to Medicaid funding almost always and the reality is that Medicaid is very lean, and states are very nimble to make the most of their Medicaid dollars. Modern Medicaid Alliance and other advocates should continue to share what Medicaid can do but the fact that Medicaid is doing it without a lot of dollars is a really important message to share with the public. 

Modern Medicaid Alliance: Why is Medicaid funding important to help support mothers and their children?

Johanna Lister: Medicaid is counter-cyclical so when the economy takes a downturn, we need Medicaid more than ever. It absolutely is the safety net and as a result of COVID-19, what we’re seeing in terms of the healthcare sector and the impacts on the economy, there are going to be a lot more people that need Medicaid. Now is the time to be having conversations on how we can do that in a way that’s smart and equitable. Instead, we are hearing a lot of conversations about cutting funding, block grants and work requirements. We really need Medicaid to be at its most robust right now when the nation is going to need it the most.


Watch the video version of our Q&A here.


Johanna Lister is the Director of Policy for HealthySteps, a program of ZERO TO THREE.

As the Director of Policy, Johanna develops and implements strategies for advising the HealthySteps network on implications of relevant policy chances at the federal and state level. Johanna is also a member of the HealthySteps National Office Policy and Finance Team In this role, Johanna pursues sustainable funding for HealthySteps sites across the nations, with a particular focus in New York. She works with stakeholders, including providers, payers and states, to promote favorable reimbursement policies to help deliver critical services to children and their families in the pediatric and family medicine setting.

Prior to joining ZERO TO THREE, Johanna was a Consultant with the Advisory Board Company. In that role, she advised large health systems on strategies for growth, expansion and market differentiation. Johanna’s career has largely centered around the intersection of Medicaid and children’s systems, including the role Medicaid plays in child welfare, special education and school-based health services and juvenile justice. Johanna has a Bachelor of Arts degree in Philosophy and Global Public Health and a Masters of Public Health from George Washington University. She also has a law degree, specializing in health law, from the University of Maryland.